Which medications increase the risk of falls? A comprehensive guide for prevention

According to the Centers for Disease Control and Prevention (CDC), one in four older adults falls each year. Certain medications are a significant, but often overlooked, contributor to this statistic by causing side effects like dizziness, sedation, and impaired balance. Understanding which medications increase the risk of falls is the first step toward proactive prevention and safer living.

Quick Summary

This article explains how certain drug classes, such as psychotropics, antihypertensives, and opioids, can increase fall risk. It details the mechanisms behind these side effects and provides actionable steps for patients and caregivers to mitigate dangers.

Key Points

• Psychotropic medications increase fall risk: Drugs like antidepressants, benzodiazepines, and antipsychotics can cause sedation, dizziness, and impaired balance, leading to a higher risk of falls.

• Blood pressure drugs can cause orthostatic hypotension: Certain antihypertensives and diuretics can cause a sudden drop in blood pressure when standing, resulting in dizziness and falls.

• Pain and sleep medications are major culprits: Opioids, muscle relaxants, and older antihistamines (found in many sleep aids) have sedative effects that significantly increase fall risk.

• Polypharmacy multiplies the risk: Taking multiple medications simultaneously, especially from different drug classes, can increase the combined effect of side effects, compounding the danger of falling.

• Medication review is key to prevention: Regularly reviewing all prescriptions and over-the-counter medications with a doctor or pharmacist is critical for identifying potential fall hazards.

• Lifestyle changes complement medication management: Implementing strategies like regular exercise and home safety modifications can significantly reduce the risk of medication-related falls.

How Medications Can Impact Balance and Stability

Medication-related falls are a significant health concern, particularly among older adults and those taking multiple prescriptions, a condition known as polypharmacy. Drugs can increase the risk of falls through several mechanisms, including causing side effects that impair balance, such as dizziness, sedation, and orthostatic hypotension. Some medications also directly affect the central nervous system, slowing reaction times and reducing alertness.

Medications That Increase the Risk of Falls

Several classes of drugs are known to be associated with an elevated fall risk. Understanding these categories is essential for identifying potential hazards in a patient’s medication regimen.

Psychotropic Medications

These drugs affect the central nervous system and are consistently linked to a higher risk of falls.

• Antidepressants: Both older tricyclic antidepressants (TCAs) and newer selective serotonin reuptake inhibitors (SSRIs) can increase fall risk, with the risk often highest in the initial weeks of treatment. Side effects include sedation, dizziness, and a drop in blood pressure.
• Benzodiazepines and Hypnosedatives: Used to treat anxiety and insomnia, these drugs, such as Xanax (alprazolam) and Ambien (zolpidem), can cause daytime drowsiness, confusion, and impaired coordination. The risk increases with long-term use and higher doses.
• Antipsychotics: Prescribed for conditions like schizophrenia and bipolar disorder, antipsychotics can cause orthostatic hypotension and sedation, which contribute to fall risk.

Blood Pressure and Cardiovascular Medications

While essential for managing heart health, some heart and blood pressure drugs can lead to dangerous drops in blood pressure, especially when standing up quickly.

• Antihypertensives: Certain blood pressure-lowering medications like alpha-blockers (e.g., prazosin, terazosin) and diuretics (e.g., furosemide, hydrochlorothiazide) can cause orthostatic hypotension. This effect is particularly prominent when starting a new medication or increasing a dose.
• Nitrates: Used to treat chest pain, nitrates can cause vasodilation, leading to a drop in blood pressure and potential fainting.

Other Notable Medication Categories

• Opioids: Powerful pain relievers like oxycodone and morphine cause sedation, dizziness, and cognitive impairment. This makes them particularly risky for falls, especially when combined with other sedating medications.
• Muscle Relaxants: Prescribed for muscle spasms and pain, muscle relaxants often cause sedative effects that impair balance and coordination.
• Older Antihistamines: First-generation antihistamines, such as diphenhydramine (Benadryl), cause significant drowsiness and sedation. These are often found in over-the-counter sleep aids and cold medications.
• Anticonvulsants (Antiepileptics): These medications can cause sedation, dizziness, and impaired balance, especially early in treatment. Some, like gabapentin, are also used for nerve pain and carry a similar risk.

Polypharmacy: The Compounding Effect

Taking multiple medications, or polypharmacy, is a major risk factor for falls. When multiple drugs, each with a small chance of causing dizziness or sedation, are taken together, their combined effect can be much greater. Studies show a stronger link between falls and the type of medication taken rather than simply the number, though the likelihood of taking a fall-risk-increasing drug (FRID) increases with the number of prescriptions.

Strategies to Mitigate Medication-Related Fall Risk

Working with your healthcare team is crucial to managing and reducing medication-related fall risk. Several proactive steps can be taken to enhance safety and well-being.

Regular Medication Reviews

Conducting a regular review of all medications, including prescriptions, over-the-counter drugs, and supplements, is vital. A pharmacist or doctor can identify potential interactions and evaluate if the benefits of a drug outweigh the risks, particularly for older adults.

Adjusting Timing and Dosage

For some medications, adjusting the timing of doses can be helpful. Taking a drug that causes drowsiness at bedtime, for example, can reduce daytime fall risk. Your healthcare provider may also consider reducing the dosage to the lowest effective level or tapering off unnecessary medications entirely, a process known as deprescribing.

Lifestyle and Environmental Changes

Beyond medication management, other changes can significantly reduce fall risk.

• Exercise: Regular physical activity, such as walking or Tai Chi, can improve strength, balance, and coordination.
• Environmental Safety: Removing hazards from the home, improving lighting, and installing grab bars can make living spaces safer.
• Assistive Devices: For individuals with mobility issues, a cane or walker can provide added stability.

Fall Risk Medications: Comparison Table

Medication Class	Primary Risk Factor(s)	Example Drugs	Who is at Highest Risk?
Psychotropics	Sedation, dizziness, impaired cognition	Alprazolam (Xanax), Trazodone, Zolpidem (Ambien), Haloperidol	Older adults, new users, those on high doses or multiple sedating meds
Antihypertensives	Orthostatic hypotension, dizziness	Lisinopril, Furosemide (Lasix), Prazosin	Older adults, individuals with a history of falls or existing hypotension
Opioids	Sedation, dizziness, impaired thinking	Oxycodone, Morphine, Methadone	High-dose users, long-term users, those on multiple sedating drugs
Anticonvulsants	Sedation, dizziness, confusion	Gabapentin (Neurontin), Pregabalin (Lyrica)	New users, those on high doses
Muscle Relaxants	Sedation, impaired coordination	Baclofen, Cyclobenzaprine	Those on higher doses or combining with other sedating agents

Conclusion: A Proactive Approach to Prevention

While many medications are vital for managing health conditions, it is important to be aware of how they can influence fall risk. A significant portion of fall injuries in older adults is linked to medication use, highlighting the importance of cautious prescribing and regular evaluation. By working closely with healthcare professionals, patients and caregivers can identify risky medications, explore safer alternatives, and implement strategies to minimize the dangers. Open communication with doctors and pharmacists is the most effective tool for balancing health needs with fall prevention. Always consult a healthcare provider before making any changes to your medication routine.

Learn More

For additional resources on fall prevention and medication safety, consult the Centers for Disease Control and Prevention (CDC)'s STEADI (Stopping Elderly Accidents, Deaths & Injuries) materials: https://www.cdc.gov/steadi/patient.html.

Frequently Asked Questions

What are the most common types of medication that increase fall risk?

Common types of medications that increase fall risk include psychotropic drugs (antidepressants, benzodiazepines), blood pressure medications, opioids, muscle relaxants, and older antihistamines.

How does medication cause falls?

Medications can cause falls by inducing side effects such as dizziness, drowsiness, sedation, orthostatic hypotension (a sudden drop in blood pressure when standing up), confusion, and impaired balance or coordination.

Are new prescriptions riskier for falls?

Yes, studies show that the risk of falls is often highest in the first few weeks after starting a new medication or increasing a dose, as the body adjusts to the drug.

Does taking more medications increase my risk of falling?

Yes, a condition called polypharmacy (taking multiple medications) significantly increases the risk of falls, especially if the regimen includes several fall-risk-increasing drugs (FRIDs).

What should I do if I think my medication is making me feel dizzy or unsteady?

If you experience dizziness or unsteadiness, talk to your doctor or pharmacist immediately. They can review your medication list, check for potential interactions, and possibly adjust your dosage or switch you to a safer alternative.

Can over-the-counter medications increase my fall risk?

Yes, older, first-generation antihistamines like diphenhydramine, often found in over-the-counter sleep aids and cold medicine, can cause significant drowsiness and increase fall risk.

How can a medication review help prevent falls?

A medication review conducted by a healthcare provider can identify potentially inappropriate medications, check for harmful drug-to-drug interactions, and determine if lower doses or alternative, safer drugs are appropriate, all of which help reduce fall risk.